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KiNH Ndi NHA N HAU PHONG C6 DINH Vdl KEO FIBRIN

-sr.

(Dich tw Ocular Surgery News Europe/ Asia -

Pacific Edition March 1, 2008)

Amar Agarwal, MS, PROS, FRCOphth; A.Dhivya,

MD; Soosan Jacob, MS, PROS, Dip NB; Athiya

Aganval, MD, DO; Chandresh Bald, MS.

Mdt ky thuat mdi dya tr§n keo vdi kinh npi nh§n

trdn nhij'ng mit thidu sy ehdng dd' cua bao sau.

Chung tdi d§ phat minh ra mdt ky thuSt phiu thuSt

mdi v l dat kinh ndi nhSn hSu phdng su" dyng keo

sinh hpc tr§n nhO'ng mlit thilu hay khdng cdn bao

sau. Chung tdi su" dyng mdt chit keo fibrin tac dyng

nhanh chiit suit tu" huylt tuo'ng mau ngudi, cd ca

hai dSc tinh dinh kit va elm mau.

lOL c6 djnh cung m^c

Dat kinh nOi nhSn tr6n nhO'ng mit thilu sy ehdng

dd" eua bao sau d§ dup-c thye hi§n trydc dSy vdi lOL

cd djnh mdng mit, lOL tiln phdng va cd djnh lOL

xuySn cung mgc qua rSnh th i mi hay pars plana. Ky

nSng phiu thu$t, thdi gian phiu thuSt k6o dai, vi§m

nhilm do khau, thoai biln chi khSu va ban l$ch hay

Jdch lOL ch$m do dirt chi la nhu'ng gidi hgn cua lOL

khSu cd djnh eung mac.Vi$c dilu ehinh chinh xae va

hoan hao dd dai va su-e cSng cua chi khSu d l bSo

dam sy djnh tam tdt cua lOL ed djnh cung mac la khd

khan va eIn nhilu thdi gian.

,T Keo fibrin

Keo fibrin da dup-c su" dyng trudc dSy trong nhilu

ITnh vyc y hpc nhu chit trung gian huylt tinh d l cim

mau, han md va hd trp' lanh vit thucng. Loai kec

ehiing tdi su- dyng la ReliSeal (Reliance life

Sciences).' Nd dup'c ddng gdi va chu'a fibrinogen

ngudi ddng khd (20mg/0.5ml), thrombin ngud'i ddng

khd (250IU/0.5ml), dung djch aprotinin (1500KIU

trong 0.5ml), mdt dng nudc vd khuin, 4 kim 21, 2 kim

diu til 20,1 kep vdi 2 mlu, va 1 dyng cy din dudng.

Ky thuat phiu thu$t:

Sau khi d$t dng truyin djch hay dung cy duy tri

tiln phdng, thye hidn md kit mac. Tgo 2 vat eung

mgc mdt phin chieu dly vdi day v l phia vung ria

kich thudc 3x3mm theo toic 180° va ca,ch ria khoing

1.5mm. Thye hi$n cit pha 16 th i trudc qua pars

plana hay dudng phia trud'c d l logi bd nhung eo k6o

djch kinh. Diing kim 22 tgo 2 l6 cung mgc thing gdc

dudi vgt cung mgc. Hai id cung mgc dup'c d$t theo

each. Id trdn sat vdi bd trSn cua vgt, Id dudi sat vdi

bd dudi cug vgt. Vgt dup'c thye hi$n d phin tu mui

tr6n va thai duo'ng dudi.

DOAN KIM THANH

B$ mdn mit DHYK Ph^m Nggc Th§ch

Dudng him cung mgc dup'c thye hign d l chuin

bj cho vi$c cai lOL. Mpt tay giu lOL bing kep Mc

Pherson, mdt tay su" dyng kep diu 25 qua Id cung

mgc kep giu liy diu cang lOL k6o qua lo eung mgc

dudi theo chilu cong cua cang va dua ra ngoai dudi

vgt cung mac dudi. Tucng ty cang edn Igi cung

dup'c dua ra qua id cung mgc tr§n dudi vat cung

mgc. Sau dd nhd keo fibrin dudi vgt cung mac tr6n va

dudi. £p tren vgt khoang 10 den 20 giay d l tgo clu

polypeptides fibrin. Liy dyng cy giCJ" tiln phdng. Ket

mac eung duac ddng vdi keo fibrin.

Trong trudng hp'p bpnh nhSn bj l^ch lOL, tao vgt

cung mgc tucng ty va cang lOL l$ch dup'c gIp vdi

kep diu 25 dua ra ngoai va dup'c dan keo dudi vgt

cung mgc. Nlu cang lOL bj trdi ra dudi vgt eung mgc,

cang cd thi dup'c gai vao dudng ham cung mgc.

Theo ddi bing OCT ban phin trudc cho thIy sy dinii

vgt cung mgc h$u phiu hoan hao sdm vao ngay thif

1 va duy tri tdt sau 1 tuln va 2 thang.

Ban luSn:

Ky thuat dat kinh ndi nhSn h$u phdng khdng khau

vdi keo fibrin se hu'u dung trong nhilu trudng hpp

l§m sang cd chi djnh d§t 101 cd djnh cung mgc nhu

ISch, ban l$ch lOL, b$nh ly day zinn hay dat lOL thip

phat. Trong trudng hp'p lOL PMMA hau phdng bj

lech, lOL dd cd th i dup'c sir dyng Igi, do dd iam giam

thao tac bo'n. Sy bdc Id ra ngoai cua phin Idn cang

theo chilu cong iam dn djnh tryc cua lOL va do d6

ng§n ngua sy nghi§ng cua lOL. Vdi 12 mit cua 12

b^nh nhSn, khdng cd bien chu-ng nao nhu vi6m

nhilm h$u phiu, xuit huylt tiln phdng, glaucoma

hay phu giae mgc g$p phli sau theo ddi thudng quy.

Chung tdi hy vpng ty 1$ thip cua hdi chirng xuit

huylt tiln phdng - glaucoma - viSm mang bo dao

trong d$t lOL vdi keo fibrin so vdi d$t lOL cd djnh

cung mgc cd khSu. Trong logi trudc, lOL dupe c6

djnh tdt va dup'c gai vao giudng cung mgc va do dd

iam giam sy di chuyin ndi nhSn. Trong logi sau, c6

tang kha nang di chuyin cua lOL hay sy cha xat

thudng xuy§n tren th i mi. Nhij'ng biln chung thj giae

dang k l la do ban l$ch tri, xay ra vdi lOL cd djnh

cung mgc cd khSu cd th i tranh dupe. Han nu'a,

nhO-ng biln chirng thudng gSp cua d^t lOL thii' phat,

nhu glaucoma thu- phat, phii hoang dilm dgng nang,

hay b$nh ly phinh d§n giae mgc, khdng g$p d nhOng

b$nh nhan cua chung tdi. Mdt thu$n Ip-i quan trpng

khac cua ky thu$t nay la ngSn ngua nhO-ng biln

10 Y HOC THU'C HANH (741) - SO 11/2010